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Effect of the Introduction of an Engineered Sharps Injury Prevention Device on the Percutaneous Injury Rate in Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Madelyn Azar-Cavanagh ,
Pam Burdt  and
Judith Green-McKenzie
Madelyn Azar-Cavanagh
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia Occupational and Environmental Center, University of California, San Diego
Pam Burdt
Affiliation:
Postexposure Management Program, Occupational and Environmental Center, University of California, San Diego
Judith Green-McKenzie*
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia
*
3400 Spruce Street, Hospital of the University of Pennsylvania, Division of Occupational Medicine, Ground Silverstein, Philadelphia, PA 19104 ([email protected])
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Abstract

Objective.

To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs).

Methods.

We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used.

Intervention.

Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention.

Results.

After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P < .01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P < .008).

Conclusion.

ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 2 , February 2007 , pp. 165 - 170
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Moran, GJ. Emergency department management of blood and body fluid exposures. Ann Emerg Med 2000;35:47–62.Google Scholar
2.Do, AN, Cielsielski, CA, Metler, RP, et al. Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States. Infect Control Hosp Epidemiol 2003;24:86–96.Google Scholar
3.Behrman, AJ, Shofer, FS, Green-McKenzie, J. Trends in bloodborne pathogen exposure and follow-up at an urban teaching hospital: 1987-1997. J Occup Environ Med 2001;43:4:370–376.Google Scholar
4. US Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens;needlestick and other sharps injuries: final rule. Federal Register 66 (2001).Google Scholar
5.Sepkowitz, K. Occupationally acquired infections in health care workers Part II. Ann Int Med 1996;125:917–928.Google Scholar
6.Bell, DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997;102:9–15.Google Scholar
7.Werner, BG, Grady, GEAccidental hepatitis-B-surface antigen-positive inoculations. Use of e antigen to estimate infectivity. Ann Intern Med 1982;97:367–369.Google Scholar
8.Alter, MJ. The epidemiology of acute and chronic hepatitis C. Clin Liver Dis 1997;1:559–568.CrossRefGoogle ScholarPubMed
9.Lanphear, BP, Linneman, CC Jr, Cannon, CG, DeRonde, MM, Pendy, L, Kerley, LM. Hepatitis C virus infection in healthcare workers: risk of exposure and infection. Infect Control Hosp Epidemiol 1994;15:745–750.Google Scholar
10.Mitsui, T, Iwano, K, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992;16:1109–1114.Google Scholar
11.Ippolito, G, Puro, V, De Carli, G. The risk of occupational human immunodeficiency virus in healthcare workers. Italian multicenter study. Arch Intern Med 1993;153:1451–1458.Google Scholar
12.Fahey, BJ, Koziol, DE, Banks, SM. Henderson, DK. Frequency of nonparenteral occupational exposures to blood and body fluids before and after universal precautions training. Am J Med 1991;90:145–153.Google Scholar
13.Stricof, RL, Morse, DL. HTLV-III/LAV seroconversion following a deep intramuscular needlestick injury. New Engl J Med 1986;314:1115.Google Scholar
14.Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Morb Mortal Wkly Rep 2001;50:1–52.Google Scholar
15.HIV/AIDS surveillance report. Vol. 12. No. 1. Atlanta: Centers for Disease Control and Prevention; 2000:24.Google Scholar
16.Cardo, DM, Culver, DH, Ciesielski, CE, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997;337:1485–1490.Google Scholar
17.Gerberding, JL. Occupational exposure to HIV in health care settings. N Engl J Med 2003;348:826–833.Google Scholar
18.Wang, SA, Panillo, AL, Doi, PA, et al. Experience of healthcare workers taking postexposure prophylaxis after occupational HIV exposures: findings of the HIV Postexposure Prophylaxis Registry. Infect Control Hosp Epidemiol 2000;21:780–758.Google Scholar
19.Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after HIV exposures worldwide, 1997-2000. MMWR Morb Mortal Wkly Rep 2001;49:1153–1156.Google Scholar
20.Centers for Disease Control and Prevention. Protection against viral hepatitis: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep 1990;39(RR-2):1–26.Google Scholar
21.Grady, GF, Lee, VA, Prince, AM, et al, Hepatitis B immune globulin for accidental exposures among medical personnel: final report of a multicenter controlled trial. J Infect Dis 1978;138:625–638.Google Scholar
22.Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) and HCV-related chronic disease. MMWR Recomm Rep 1998;47(RR-19):1–39.Google Scholar
23.Centers for Disease Control. Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymph-adenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34:681-686, 691–695.Google Scholar
24.Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in health-care settings. MMWR Morb Mortal Wkly Rep 1987;36:1S–18S.Google Scholar
25.Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens;final rule. Federal Register 56 (1991).Google Scholar
26.Udasin, IG, Gochfield, M. Implications of the Occupational Safety and Health Administration's bloodborne pathogen standard for the occupational health professional. J Occup Med 1994;36:548–544.Google ScholarPubMed
27.Gershon, RRM, Vlahov, D, Felknor, S, et al. Compliance with universal precautions among healthcare workers at three regional hospitals. Am J Infect Control 1995;23:225–236.CrossRefGoogle ScholarPubMed
28.Green-McKenzie, J, Gershon, RMM, Karkashian, C. Infection control practices among correctional healthcare workers: effect of management attitudes and availability of protective equipment and engineering controls. Infect Control Hosp Epidemiol 2001;22:555–559.CrossRefGoogle ScholarPubMed
29.Panlilio, AL, Orelien, JG, Srivastava, PU, et al. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol 2004;25:556–562.Google Scholar
30.Orenstein, R, Reynolds, L, Karabaic, M. Do protective devices prevent needlestick injuries among health care workers? Am J Infect Control 1995;23:344–351.Google Scholar
31.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health care workers during phlebotomy procedures—Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR Morb Mortal Wkly Rep 1997;46:21-5.Google Scholar
32.Association for Professionals in Infection Control and Epidemiology. APIC position paper: prevention of device-mediated bloodborne infections to health care workers. Am J Infect Control 1988;26:578–580.Google Scholar
33.Krasinski, K, LaCouture, R, Holzman, RS. Effect of changing needle disposal systems on needle puncture injuries. Infect Control 1987;8:59–62.Google Scholar
34.Gillen, M, McNary, J, Lewis, J. Sharps-related injuries in California healthcare facilities: pilot study results from the sharps injury surveillance registry. Infect Control Hosp Epidemiol 2003;24:113–121.Google Scholar
35.Alvarado-Ramy, F, Beltrami, EM, Short, LJ. A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multi-center study, 1993-1995. Infect Control Hosp Epidemiol 2003;24:97–104.Google Scholar
36.Mendelson, MH, Bao, YL, Solomon, R, et al. Evaluation of a safety resheathable wing steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among health care workers. Infect Control Hosp Epidemiol 2003;24:105–112.Google Scholar
37.Perry, J, Parker, G, Jagger, J. EPINet Report: 2001 percutaneous injury rates. Advances in Exposure Prevention 2003;6:32–37.Google Scholar
38.Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR Morb Mortal Wkly Rep 1998;47(RR-7):1–33.Google Scholar
39.Sohn, S, Eagan, J, Sepkowitz, KA. Safety-engineered device implementation: does it introduce bias in percutaneous injury reporting? Infect Control Hosp Epidemiol 2004;25:543–547.Google Scholar
40.Chiarello, LA. Selection of needlestick prevention devices: a conceptual framework for approaching product evaluation. Am J Infect Control 1995;23:386–395.Google Scholar
41.Lorentz, J, Hill, L, Samimi, B. Occupational needlestick injuries in a metropolitan police force. Am J Prev Med 2000;18:146–50.Google Scholar
42.Jagger, JB, Bentley, MB. Injuries from vascular access devices: high risk and preventable. Collaborative EPINet Surveillance Group. J Intraven Nurs 1997;20:S33-9.Google Scholar
43.Sejean, S, Eagan, J, Sepkowitz, KA, Zuccotti, G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp Epidemiol 2004;25:536–542.Google Scholar
44.GAO US General Accountability Office. Occupational safety: selected cost and benefit implications of needlestick prevention devices for hospitals. 2000;GAO-01-60R Needlestick Prevention. Available at: http://www.gao.gov. Accessed January 16, 2007.Google Scholar
45.Landrigan, CP, Rothschild, JM, Cronin, JW, Kaushal, R, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med 2004;351:1838–1848.Google Scholar
46.Clarke, SP, Rockett, JL, Sloane, DM, Aiken, LH. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near misses in hospital nurses. Am J Infect Control 2002;30:207–216.Google Scholar
47.Wenzel, P. Patient-to-patient transmission of hepatitis C virus. Ann Int Med 2005;142:940–941.Google Scholar
48.Vaughn, TE, McCoy, K, Beekman, SE, Woolson, RF, Tomer, JC, Doebbling, BN. Factors promoting consistent adherence to safe needle precautions among hospital workers. Infect Control Hosp Epidemiol 2004;25:548–555.CrossRefGoogle ScholarPubMed